Radical Splenic Flexurectomy versus Left Hemicolectomy in Patients with Splenic Flexure Carcinoma

Background: Splenic flexure carcinoma (SFC) is a rare type of colorectal cancer, representing less than 8% of cases, and is often associated with delayed diagnosis and poor prognosis. Surgical management options include radical splenic flexurectomy and left hemicolectomy, but evidence comparing perioperative, oncologic, and short-term outcomes is limited. This study aimed to compare radical splenic flexurectomy with left hemicolectomy in terms of oncologic adequacy, perioperative outcomes, postoperative recovery, and short-term complications in patients with SFC. Methods: This prospective randomized study included 24 patients with SFC at Zagazig University Hospitals over six months. Patients were randomized into two groups: radical splenic flexurectomy(n=11) and left hemicolectomy(n=13). Preoperative assessment, laparoscopic surgical procedures, postoperative follow-up, and histopathological evaluation were standardized. Outcomes measured included R0 resection, lymph node harvest, operative time, blood loss, hospital stay, time to first flatus and stool, postoperative complications, and six-month follow-up data. Results: Both surgical approaches achieved R0 resection in all patients, with mean lymph node yields of 25.9 and 26.5 for radical splenic flexurectomy and left hemicolectomy, respectively. Operative times, blood loss, and postoperative recovery parameters were comparable between groups. Overall complication rates were 36.4% and 23.1%, with one mortality and one anastomotic leak in the left hemicolectomy group. No recurrences were observed at six months follow-up. Conclusion: Radical splenic flexurectomy and left hemicolectomy provide equivalent short-term oncologic and clinical outcomes in SFC. Surgical approach selection should be individualized based on patient and tumor characteristics, with emphasis on achieving negative margins, adequate lymphadenectomy, and minimally invasive techniques whenever feasible.